Building
on his experience as both a practicing physician and corporate health care
leader, Dr. K. James Ehlen shared his views of the future of the health
system in a noontime seminar at LDI. In his presentation, Dr. Ehlen
challenged the audience with two central questions: “What do we know today
that will shape the health care system of tomorrow?” and “What have we
learned from the past that can help us reshape the future?”

He
began with a review of some of the forces at work in our present system.
They include a deeply held belief that the individual should be in control
of his or her own health care choices, a trend he called “consumerism”.
This trend, coupled with the advent of new technologies, has resulted in
extraordinary cost pressures within the system. New technologies,
Dr. Ehlen stated, “can produce stunning results and will produce stunning
costs.”

These
cost pressures have led to payment and reimbursement policies that have
produced frustrated physicians and dangerously low operating margins for
hospitals. “If the system is going to improve itself, we must find
a method for engaging physicians and other providers in producing solutions,”
he noted. New market models, he said, must recognize the patient-doctor
relationship as the center of decisionmaking and center of responsibility.

Part
of the solution, Dr. Ehlen said, is effective and creative use of information
capabilities to reinforce the “right” behaviors in each stakeholder (hospital,
doctor, patient, plan). “The combination of a telephone line, a PC,
and a television…will fundamentally change the way we manage and deliver
health care. By connecting with individuals, health care consumers…medical
advice and counsel becomes available on their terms, [making them] more
accountable for their own actions and the choices they make.”

As
an example, Dr. Ehlen mentioned a successful pilot program in Minnesota
that improved care of patients with congestive heart failure. Through alignment
of incentives among a medical clinic, a health plan, and a hospital system,
readmission rates fell dramatically, patient satisfaction increased, and
health care costs were reduced by about $500,000 per year. The key
to this pilot, Dr. Ehlen noted, was the 24- hour availability of a nurse
clinician who had online medical records on a laptop computer. Patients
had much greater access to timely, relevant information about their care
from a health professional who had their records—thus avoiding many emergency
room visits and duplicate tests.

“We
have today the capability of knowing what the right care is, who should
provide it, and when and where that care should occur,” Dr. Ehlen said.
However, these “best practices” are often not implemented because the health
care system does not reinforce movement toward these kinds of improvements.
He cited geographic variations in care and medical errors as instances
in which “best practices” could result in substantial clinical improvement,
cost savings and a better patient experience. “The death rate in
the U.S. from medical errors is equivalent to a full 747 airliner crashing
each day. Why aren’t we asking and doing more about this?” Dr. Ehlen
asked.

Reducing
the rate of medical mistakes, Dr. Ehlen stated, will mean changing the
processes of care that lead to improved patient safety. “This will happen
only with deeply committed leadership from physicians and other clinicians,”
he explained.

Looking
ahead, Dr. Ehlen said that the leaders of the future will need to make
a commitment to improving the health of individuals and the health of communities.
Addressing the underlying causes of illness, in many cases, will require
that leaders reach across unnatural boundaries and create working relationships
with public and private organizations, and even among competitors.
Looking “upstream” means addressing issues such as tobacco and alcohol
use, violence, and unsafe behaviors before they manifest themselves as
heart disease, diabetes, homicide and suicide.

“We
have the necessary components to dramatically change the way health care
is delivered,” Dr. Ehlen stated. “Now we have to arrange the parts
to work together.”

Dr.
Ehlen ended his presentation with a quote from Yogi Berra: “The future
ain’t what it used to be.”

Biosketch:
K. James Ehlen, MD

K. James Ehlen, MD, is the
co-founder and immediate past president of the Allina Health System, a
not-for-profit integrated health system, dedicated to community health
improvement.

Prior to Allina, Dr. Ehlen
was chief executive officer of Medica which grew to become Minnesota's
largest managed care organization under his leadership. Before venturing
into corporate health care management, Dr. Ehlen was a practicing endocrinologist
in Minneapolis for twelve years.

He currently serves on the
Health Forum Board as its vice-chairman, the VHA Foundation Board as its
chairman, and also serves on the Board of Directors of the MMI Companies.
He is the immediate past chairman of Minnesota Meeting, a Twin Cities based
venue for presentations by nationally recognized speakers on key
societal issues.

Dr. Ehlen holds a clinical
professorship in the School of Medicine at the University of Minnesota
in the Department of Medicine. He lectures at the University of Minnesota
and the St. Thomas University.

An advocate for the community
and volunteer organizations, he has supported a variety of efforts focused
on community health improvement. A leader in business and community,
he takes pride in his role as visionary, teacher, consensus builder as
he applied these capabilities in his various responsibilities.

Abstract:"What Will the
New Leaders Be Leading?"

The Environment:
A review of compelling forces in the environment that are provoking undeniable
changes in the health system and how it will work.

The Future: A discussion
of three facets of the health system and what kind of challenges and solutions
to expect. These comments will focus on:

Market Reform and what needs to change
Changing the way in which care is delivered to achieve better clinical
and economic outcomes
The value of continuing to focus on efforts to achieve improvements in
health and the health of communities.